Background: The optimal surgical approach for benign thyroid nodules remains controversial. This study aimed to compare the outcomes of total thyroidectomy versus hemithyroidectomy for benign thyroid nodules to inform clinical decision-making.

Methods: A prospective observational study was conducted on 70 patients (32 total thyroidectomy, 38 hemithyroidectomy) with benign thyroid nodules who underwent surgery between January and December 2024. Outcomes assessed included perioperative parameters, complications, functional outcomes, quality of life, and recurrence rates.

Results: The total thyroidectomy group had significantly larger nodules (3.8±1.2 vs. 3.2±0.9 cm, p=0.022) and higher prevalence of multinodular goiter (75.0% vs. 44.7%, p=0.011). Total thyroidectomy was associated with longer operative time (128.4±31.2 vs. 89.6±24.5 minutes, p<0.001), greater blood loss (78.5±36.2 vs. 52.3±28.7 mL, p=0.001), and extended hospital stay (3.2±0.9 vs. 2.1±0.8 days, p<0.001). Complication rates were significantly higher in the total thyroidectomy group (43.8% vs. 15.8%, p=0.009), primarily due to transient hypoparathyroidism (28.1% vs. 0%, p<0.001). All total thyroidectomy patients required levothyroxine compared to 18.4% in the hemithyroidectomy group (p<0.001). Quality of life assessment showed better overall scores in the hemithyroidectomy group (20.5±14.2 vs. 28.4±16.8, p=0.033). Among hemithyroidectomy patients, 18.4% developed new nodules and 5.3% required completion thyroidectomy within 12 months.

Conclusion: Hemithyroidectomy is associated with lower complication rates, reduced need for hormone replacement, and better quality of life compared to total thyroidectomy for benign thyroid nodules. However, these advantages must be balanced against the risk of recurrence and need for reoperation. The choice between procedures should be individualized based on patient characteristics, preferences, and risk profile.